The Centers for Medicare and Medicaid Services (CMS) began paying for a wide range of telehealth services at the start of the novel coronavirus pandemic in order to help ensure people with Medicare had access to the health care they needed. In year one of the pandemic, more than 28 million older adults and people with disabilities received telehealth services, 88 times the number of services than the prior year. The HHS Office of the Inspector General (OIG) has since discovered some serious telehealth fraud and, in a new report, recommends that CMS take several actions to protect people with Medicare and minimize fraud, waste and abuse.
Between March 1, 2020 and February 28, 2021, 742,000 health care providers billed traditional Medicare or a Medicare Advantage plan for a telehealth service. Of those, the OIG found a tiny fraction, 1,714 providers whose billing practices pose “a high risk to Medicare.” They received $127.7 million for their services to 500,000 people.
Just to say it, the level of fraud detected pales in comparison to the fraud committed by Medicare Advantage plans.
It’s not clear whether these telehealth care providers delivered necessary services or, for that matter, any services at all. More than four in ten of them are associated with telehealth companies. The OIG recommends much better and targeted CMS oversight of these services. And, CMS said it would follow up on the individual providers the OIG identified.
But, CMS did not say it would look into telehealth companies, as the OIG recommended. It’s not clear why not. Right now, CMS data cannot identify these telehealth companies systematically.
The OIG found that seven mental health providers who overbilled Medicare all worked for the same mental health and substance abuse chain in Florida. And, in more than half the cases where the OIG identified suspicious billing, more than one provider was engaged in suspicious billing.
Here’s more from Just Care:
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